Women's health care services

Women's health care services including maternity care, covered reproductive health services, preventive services (well care) and general examinations, gynecology care, and follow-up visits (check the member's Evidence of Coverage to understand limitations in this area) may be obtained from Kaiser Permanente or Kaiser Permanente network providers without prior authorization. Providers include general and family practitioner, physician's assistant, gynecologist, certified nurse midwife, licensed midwife, doctor of osteopathy, pediatrician, obstetrician or advance registered nurse practitioner.

The member's primary care provider or personal physician must manage other health conditions, coordinate care, and arrange for referrals to subspecialists.

If the provider diagnoses a condition that requires hospitalization or a referral to another specialist, the member or the provider must obtain preauthorization and care coordination in accordance with applicable Kaiser Permanente requirements.

Home birth

A member's health plan may cover part or all home-birth services. A Kaiser Permanente member may self-refer to a contracted home birth practitioner for an initial examination to determine whether she meets our criteria as a candidate for home birth. These services are part of the women's health care options we offer our members. We do not require a prior authorization for ancillary services associated with typical, low-risk prenatal care such as hematocrit and glucose screening. Please use a Kaiser Permanente-owned or contracted facility for these services.

Infertility/fertility treatment

Infertility/fertility treatment is an exclusion on most plans. Large groups may purchase a benefit to provide coverage for treatment of infertility and sterility. Self-funded plans may elect to track the benefit differently if they choose to purchase a benefit. Check the Evidence of Coverage to confirm the benefit.

Termination of pregnancy

Kaiser Permanente will provide payment for abortion services and related ancillary services on most plans.

The Federal Employees Health Benefits Program (FEHBP) does not offer coverage of abortion procedures except in the following limited circumstances according to the approved plan brochure:
  1. The incidence of the pregnancy being a result of an act of rape or incest.
  2. The case where a woman suffers from a physical disorder, physical injury or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed.

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